A transdiagnostic approach of negative symptoms in psychiatric disorders: replication of a two-factor structure in major depressive disorder and bipolar disorder.

Recent empirical findings suggest that negative symptoms are not limited to schizophrenia (SCZ) but also present in major depressive disorder (MDD) and bipolar disorder (BD) patients. Although SCZ patients generally showed a latent structure comprising the motivation and pleasure (MAP) and expression (EXP) factors, it remains unclear whether the same latent structure exists in MDD and BD patients. We administered the Clinical Assessment Interview for Negative Symptoms (CAINS) and the Brief Negative Symptom Scale (BNSS) to 179 MDD patients and 152 BD patients. Confirmatory Factor Analysis (CFA) was conducted to examine the one-factor model, the two-factor model of the MAP and the EXP domain, the five-factor model of anhedonia, avolition, asociality, alogia, and blunted affect, and the hierarchical model comprising the first-order five-factor, and the second-order two-factor (MAP and EXP factors). We further examined the correlations between demographics and the negative symptom dimensions found in the best factor model. The CFA showed that, when the CAINS and the BNSS were combined together, the two-factor model of MAP and EXP provided the best model fit than other competing models, in the MDD alone sample, BD alone sample, and the combined clinical sample. The two-factor model of the MAP and EXP appears to be a stable, transdiagnostic latent structure of negative symptoms across BD and MDD. Clarifying negative symptoms in MDD and BD can facilitate future research on the underlying neural mechanisms of the MAP and EXP dimensions.

Prospective Evaluation of Abelchia/RCPD Patients: Abnormalities in High-Resolution Esophageal Manometry.

Self-diagnosis of retrograde cricopharyngeus dysfunction (RCPD) or abelchia has been increasing over the past 5 years with patients seeking treatment for lifelong symptoms of inability to burp, neck gurgling, bloating, and flatulence. There is a distinct paucity of objective data in diagnosis and underlying pathophysiology of this disorder. OBJECTIVE: The purpose of this study was to prospectively evaluate patients with abelchia using standardized investigations to explore possible underlying mechanisms. METHODS: Patients presenting with clinical scenario consistent with RCPD were recruited into the study after informed consent. All patients underwent standardized investigations: Self reporting questionnaires EAT-10, VHI-10, and RSI scores, as well as esophagogastroscopy, barium swallow, and high-resolution esophageal manometry (HRM), were performed. RESULTS: RCPD patients demonstrated a minor increase in the mean EAT-10 (5.2 ± 1.2) and normal RSI/VHI-10 scores. Barium swallow revealed 53% (CI 38%-64%) were abnormal with reflux with hiatus hernia (37%) and dysmotility (16%) as most common findings. HRM showed that 67% (CI 54%-78%) were abnormal. Ineffective motility was found in 41%, a further 23% showed a complete absence of peristalsis, whereas 33% were normal. CONCLUSIONS: RCPD is a clinical condition of lifelong inability to belch and associated symptoms. The underlying pathophysiology is poorly understood. This study demonstrates that a significant number of RCPD patients have abnormal esophageal neural network with high proportion of abnormal or absent esophageal peristalsis. LEVEL OF EVIDENCE: 3 Laryngoscope, 2024.

A Transdiagnostic Network Analysis of Childhood Trauma and Psychopathology.

BACKGROUND AND HYPOTHESIS: Psychiatric comorbidities suggest that symptoms overlap across different diagnoses; the transdiagnostic network approach is valuable for studying psychopathology. Childhood trauma is a common transdiagnostic risk factor for psychiatric disorders, but the complex relationship between childhood trauma and psychopathology has seldom been investigated using a large cross-sectional transdiagnostic sample. STUDY DESIGN: This study recruited 869 patients with different diagnoses, including 418 schizophrenia, 215 bipolar disorder, and 236 major depressive disorder. Participants completed psychiatric interviews and self-report questionnaires. We constructed dimension- and item-level Least Absolute Shrinkage and Selection Operator-based (LASSO) networks to explore the relationship between childhood trauma, psychopathology, and duration of illness. Moreover, we constructed directed acyclic graphs (DAGs) to tentatively clarify the potential directions of associations among these variables. Network Comparison Tests (NCTs) were conducted for different diagnostic groups and gender-stratified groups. STUDY RESULTS: The transdiagnostic LASSO networks showed that different types of childhood trauma exerted distinct impacts on various psychopathological dimensions. Emotional abuse was linked to depressive symptoms, physical abuse to excited symptoms, sexual abuse to positive and disorganized symptoms, emotional neglect to depressive symptoms and motivation and pleasure (MAP) deficits factor of negative symptoms, and physical neglect to MAP factor. The DAG findings generally concurred with the LASSO network. The NCT showed comparable networks. CONCLUSIONS: Our findings suggest that childhood trauma is significantly associated with the development of psychopathology across different diagnostic groups. The affective pathway model suggests that early identification and tailored interventions would be needed for people with a history of childhood trauma.

Individuals with high levels of autistic traits exhibit impaired cognitive but not affective theory of mind and empathy.

Theory of mind (ToM) and empathy are considered key components of social cognition that are often impaired in individuals with autism spectrum disorders (ASD). However, it remains unclear whether individuals with high levels of autistic traits exhibit similar impairments in these two functions. This study examined the affective and cognitive domains of ToM and empathy in individuals with high levels of autistic traits. We recruited 84 participants with high levels and 78 participants with low levels of autistic traits to complete a set of self-reported checklists and performance-based tasks capturing affective and cognitive components of ToM and empathy. The results showed that participants with high levels of autistic traits exhibited significant impairments in cognitive but not in affective ToM and empathy compared with their counterparts with low levels of autistic traits. We also found that empathy impairments in people with high levels of autistic traits were confounded by alexithymia and depressive traits.

Environmental Sustainability: Waste Audit Comparison Operating Roomand In-Office Laryngeal Surgery.

INTRODUCTION: With vast improvements in imaging and endoscopic technology, there has been a massive shift towards in office procedures for various laryngeal disorders with significant health system and patient benefits. Another benefit which has yet to be investigated is the potential environmental effects and waste reduction of in-office laryngeal procedures over traditional operating room surgery. OBJECTIVES: The purpose of this study is to perform a waste audit and compare the results between operating room and in-office laser laryngeal surgery. METHODS: Ten cases of in-office and operating room laser laryngeal surgery, performed for recurrent respiratory papillomatosis, were subjected to a waste audit with four waste streams identified. Recyclable, general waste, anesthesia source and sharps. All waste was included from the time of case preparation to termination. RESULTS: The cases were extremely homogeneous in the waste produced. The mean waste total produced for the operating room laser surgery was 2972 g of which 18% was recoverable/recyclable. Contamination rate was very low. Recycling was performed very well by nursing/prep staff; however, anesthesia was not recovering 13% of potential materials. The in-office waste produced was approximately one tenth of the operating room waste with almost all delegated into general waste. Potentially divertible/recyclable materials accounted for 38% of the waste in-office procedures. CONCLUSIONS: In-office laryngeal procedures produce 13% of waste compared to surgery performed for similar pathology. These procedures are cost effective, safe and have been demonstrated to enhance environmental sustainability. LEVEL OF EVIDENCE: NA Laryngoscope, 134:803-806, 2024.

Social and non-social reward processing in subclinical depression.

This study applied two incentive delay tasks involving social and non-social incentive types to 76 pairs of participants with high and low depressive symptoms. The results suggest that higher levels of depressive symptoms are correlated with abnormalities in social and non-social reward processing even in the healthy populations.

Range adaptive value representations in schizophrenia and major depression.

Anhedonia and amotivation are core symptoms of schizophrenia (SCZ) and major depressive disorder (MDD). Reward processing involves constructing and contrasting the representations for expected value (EV) and outcome value (OV) of a given stimulus, a phenomenon termed range adaptation. Impaired range adaptation can lead to anhedonia and amotivation. This study aimed to examine range adaptation in SCZ patients and MDD patients. Fifty SCZ, 46 MDD patients and 56 controls completed the Effort-based Pleasure Experience Task to measure EV and OV adaptation. SCZ and MDD patients showed altered range adaptation, albeit in different patterns. SCZ patients exhibited over-adaptation to OV and reduced adaptation to EV. By contrast, MDD patients exhibited diminished OV adaptation but intact EV adaptation. Both OV and EV adaptation were correlated with anhedonia and amotivation in SCZ and MDD. Taken together, our findings suggest that range adaptation is altered in both SCZ and MDD patients. Associations of OV and EV adaptation with anhedonia and amotivation were consistently found in SCZ and MDD patients. Impaired range adaptation in SCZ and MDD patients may be putative neural mechanisms and potential intervention targets for anhedonia and amotivation.

Range adaptation in schizophrenia: A one-year longitudinal study.

Range adaptation refers to the representation of a stimulus value based on its relative position in the range of pre-experienced values. Altered range adaptation in value representation may be related to motivation and pleasure (MAP) deficit in schizophrenia (SCZ). This follow-up study examined the relationship between range adaptation performance and MAP symptoms in SCZ patients. We recruited 26 schizophrenia patients and followed them for 1 year. They completed an experimental task for estimating their range adaptation to outcome value (OV) and expected value (EV) at baseline and after 1 year. At baseline, we found a marginally significant and negative correlation between OV adaptation and avolition symptoms in SCZ patients. Moreover, the 1-year change of EV adaptation was significantly and negatively correlated with the change of self-report pleasure experience. Our results suggest that range adaptation may track the variations of MAP symptoms in SCZ.

Reward motivation adaptation in people with negative schizotypal features: development of a novel behavioural paradigm and identifying its neural correlates using resting-state functional connectivity analysis.

Reward motivation in individuals with high levels of negative schizotypal traits (NS) has been found to be lower than that in their counterparts. But it is unclear that whether their reward motivation adaptively changes with external effort-reward ratio, and what resting-state functional connectivity (rsFC) is associated with this change. Thirty-five individuals with high levels of NS and 44 individuals with low levels of NS were recruited. A 3T resting-state functional brain scan and a novel reward motivation adaptation behavioural task were administrated in all participants. The behavioural task was manipulated with three conditions (effort > reward condition vs. effort < reward condition vs. effort = reward condition). Under each condition were rated 'wanting' and 'liking' for rewards. The seed-based voxel-wise rsFC analysis was conducted to explore the rsFCs associated with the 'wanting' and 'liking' ratings in individuals with high levels of NS. 'Wanting' and 'liking' ratings of individuals with high levels of NS significantly declined in the effort > reward condition but did not rebound as high as their counterparts in the effort < reward condition. The rsFCs in NS group associated with these ratings were altered. The altered rsFCs in NS group involved regions in the prefrontal lobe, dopaminergic brain regions (ventral tegmental area, substantia nigra), hippocampus, thalamus and cerebellum. Individuals with high levels of NS manifested their reward motivation adaptation impairment as a failure of adjustment adaptively during effort-reward imbalance condition and altered rsFCs in prefrontal, dopaminergic and other brain regions.

Relationship Between Interoception and Autistic Traits: A Resting-State Functional Connectivity Study.

Interoception, the sense of the physiological condition of our body, is impaired in individuals with autism spectrum disorders. Evidence suggests that subclinical autistic traits are mild manifestations of autistic symptoms, present in the general population. We examined the resting-state functional connectivity (rsFC) associating with interoception and autistic traits in 62 healthy young adults. Autistic traits correlated negatively with the rsFC between the lateral ventral anterior insula and anterior cingulate cortex. Interoceptive accuracy and sensibility correlated positively with the rsFC between interoceptive brain networks and the cerebellum, supplementary motor area, and visual regions. The results suggest that a negative relationship between interoception and autistic traits is largely accounted for by both self-report measures and decreased rsFC amongst the interoceptive brain network.

The prediction of effort-reward imbalance for reward motivation.

This sequential mediation analysis study examined how the baseline effort-reward imbalance (ERI) would predict reward motivation 1 year later in 435 college students. We found that negative/disorganized schizotypal traits and anticipatory pleasure experience together mediate the prediction of ERI for reward motivation.

Relationships between childhood trauma and dimensional schizotypy: A network analysis and replication.

OBJECTIVES: Childhood trauma (CT) has been found to increase the risk of developing schizophrenia and other psychiatric disorders. Little is known regarding the complex interplay between CT, subclinical psychotic, and affective symptoms in the general population. This cross-sectional study adopted network analysis to examine such a complex relationship. We hypothesized that CT would show strong connections with schizotypy dimensions, and the high schizotypy subgroup would show a network with higher global strength compared with the low schizotypy subgroup. METHODS: A total of 1813 college students completed a set of self-report questionnaires measuring CT, schizotypal features, bipolar traits, and depressive symptoms. The subscales of these questionnaires were used as nodes, and the partial correlations between nodes were used as edges to construct a network. Network Comparison Tests were used to investigate the differences between participants with high schizotypy and low schizotypy. An independent sample (n = 427) was used to examine the replicability of the results. RESULTS: Findings from the main dataset showed that CT was closely connected with schizotypy and motivation, after controlling for the inter-relationships between all nodes in the network. Relative to the low schizotypy subgroup, the network of the high schizotypy subgroup showed higher global strength. The two subgroups did not differ in network structure. Network analysis using the replication dataset showed comparable global strength and network structure. CONCLUSIONS: Our findings support specific links between CT and schizotypy dimensions in healthy youth populations, and such links appear to become stronger in those with high schizotypy.

Emotional subtypes in patients with depression: A cluster analysis.

Major depressive disorder (MDD) is associated with deficits in emotion experience, expression and regulation. Whilst emotion regulation deficits prolong MDD, emotion expression influences symptomatic presentations, and anticipatory pleasure deficits predict recurrence risk. Profiling MDD patients from an emotion componential perspective can characterize subtypes with different clinical and functional outcomes. This study aimed to investigate emotional subtypes of MDD. A two-stage cluster analysis applied to 150 MDD patients. Clustering variables included emotion experience measured by Temporal Experience of Pleasure Scale, emotion expression measured by Toronto Alexithymia Scale, and emotion regulation measured by Emotion Regulation Questionnaire. We validated the resultant clusters by comparing their symptoms and functioning with that of 50 controls. Cluster 1 (n = 50) exhibited intact emotion experience and expression yet adopted reappraisal rather than suppression strategy, whereas Cluster 2 (n = 66) exhibited generalized emotional deficits. Cluster 3 (n = 34) exhibited emotion expression deficits and adopted both reappraisal and suppression strategies. On validation, Cluster 2 exhibited the worst, but Cluster 1 exhibited the least symptoms and social functioning impairments. Cluster 3 was intermediate among the two other subtypes. Our findings support the existence of different emotional subtypes in MDD patients, and have clinical and theoretical implications for developing future specific treatments for MDD.

Multi-omics profiling and digital image analysis reveal the potential prognostic and immunotherapeutic properties of CD93 in stomach adenocarcinoma.

Background: Recent evidence highlights the fact that immunotherapy has significantly improved patient outcomes. CD93, as a type I transmembrane glycoprotein, was correlated with tumor-associated angiogenesis; however, how CD93 correlates with immunotherapy in stomach adenocarcinoma (STAD) remains unclear. Methods: TCGA, GTEx, GEO, TIMER2.0, HPA, TISIDB, TCIA, cBioPortal, LinkedOmics, and ImmuCellAI public databases were used to elucidate CD93 in STAD. Visualization and statistical analysis of data were performed by R (Version 4.1.3), GraphPad (Version 8.0.1), and QuPath (Version 0.3.2). Results: CD93 was highly expressed in STAD compared with adjacent normal tissues. The overexpression of CD93 was significantly correlated with a poor prognosis in STAD. There was a negative correlation between CD93 expression levels with CD93 mutation and methylation in STAD. Our results revealed that CD93 expression was positively associated with most immunosuppressive genes (including PD-1, PD-L1, CTLA-4, and LAG3), immunostimulatory genes, HLA, chemokine, and chemokine receptor proteins in STAD. Furthermore, in STAD, CD93 was noticeably associated with the abundance of multiple immune cell infiltration levels. Functional HALLMARK and KEGG term enhancement analysis of CD93 through Gene Set Enrichment Analysis was correlated with the process of the angiogenesis pathway. Subsequently, digital image analysis results by QuPath revealed that the properties of CD93+ cells were statistically significant in different regions of stomach cancer and normal stomach tissue. Finally, we utilized external databases, including GEO, TISIDB, ImmuCellAI, and TCIA, to validate that CD93 plays a key role in the immunotherapy of STAD. Conclusion: Our study reveals that CD93 is a potential oncogene and is an indicative biomarker of a worse prognosis and exerts its immunomodulatory properties and potential possibilities for immunotherapy in STAD.

Neural correlates of audiovisual speech synchrony perception and its relationship with autistic traits.

The anterior insula (AI) has the central role in coordinating attention and integrating information from multiple sensory modalities. AI dysfunction may contribute to both sensory and social impairments in autism spectrum disorder (ASD). Little is known regarding the brain mechanisms that guide multisensory integration, and how such neural activity might be affected by autistic-like symptoms in the general population. In this study, 72 healthy young adults performed an audiovisual speech synchrony judgment (SJ) task during fMRI scanning. We aimed to investigate the SJ-related brain activations and connectivity, with a focus on the AI. Compared with synchronous speech, asynchrony perception triggered stronger activations in the bilateral AI, and other frontal-cingulate-parietal regions. In contrast, synchronous perception resulted in greater involvement of the primary auditory and visual areas, indicating multisensory validation and fusion. Moreover, the AI demonstrated a stronger connection with the anterior cingulate gyrus (ACC) in the audiovisual asynchronous (vs. synchronous) condition. To facilitate asynchrony detection, the AI may integrate auditory and visual speech stimuli, and generate a control signal to the ACC that further supports conflict-resolving and response selection. Correlation analysis, however, suggested that audiovisual synchrony perception and its related AI activation and connectivity did not significantly vary with different levels of autistic traits. These findings provide novel evidence for the neural mechanisms underlying multisensory temporal processing in healthy people. Future research should examine whether such findings would be extended to ASD patients.

Altered neural mechanism of social reward anticipation in individuals with schizophrenia and social anhedonia.

Altered social reward anticipation could be found in schizophrenia (SCZ) patients and individuals with high levels of social anhedonia (SA). However, few research investigated the putative neural processing for altered social reward anticipation in these populations on the SCZ spectrum. This study aimed to examine the underlying neural mechanisms of social reward anticipation in these populations. Twenty-three SCZ patients and 17 healthy controls (HC), 37 SA individuals and 50 respective HCs completed the Social Incentive Delay (SID) imaging task while they were undertaking MRI brain scans. We used the group contrast to examine the alterations of BOLD activation and functional connectivity (FC, psychophysiological interactions analysis). We then characterized the beta-series social brain network (SBN) based on the meta-analysis results from NeuroSynth and examined their prediction effects on real-life social network (SN) characteristics using the partial least squared regression analysis. The results showed that SCZ patients exhibited hypo-activation of the left medial frontal gyrus and the negative FCs with the left parietal regions, while individuals with SA showed the hyper-activation of the left middle frontal gyrus when anticipating social reward. For the beta-series SBNs, SCZ patients had strengthened cerebellum-temporal FCs, while SA individuals had strengthened left frontal regions FCs. However, such FCs of the SBN failed to predict the real-life SN characteristics. These preliminary findings suggested that SCZ patients and SA individuals appear to exhibit altered neural processing for social reward anticipation, and such neural activities showed a weakened association with real-life SN characteristics.

Characterizing emotion profiles in non-clinical population: A cluster analytical study.

Emotion processing and beliefs about pleasure can influence the development and severity of depressive symptoms. This cluster analysis study aimed to profile a large sample of college students using pleasure experience, emotion expression and regulation as well as beliefs about pleasure. We also aimed to validate the resultant clusters in terms of depressive symptoms. A set of checklists capturing beliefs about pleasure and the three facets of emotion processing was administered to 1028 college students. A two-stage cluster analysis was used to analyze the profile of these emotional aspects in these college students. Our results showed that a three-cluster solution best fit the data. Cluster 1 (n = 536) was characterized by moderate levels of beliefs about pleasure, pleasure experience, emotion expression, and regulation; Cluster 2 (n = 402) was characterized by generally high levels of beliefs about pleasure, pleasure experience, emotion expression, and regulation; Cluster 3 (n = 90) was characterized by relatively low levels of beliefs about pleasure, pleasure experience, emotion expression, and regulation. The three clusters differed significantly in the severity of depressive symptoms. Our findings suggest the existence of three emotional subtypes, which may be useful in early detection of youth at risk of developing depression.

Negative schizotypal traits predict the reduction of reward motivation in effort-reward imbalance.

The schizotypy construct is useful for studying the effects of environmental stress on development of subclinical negative symptoms. The relationship among self-report motivation, effort-reward imbalance (ERI), and schizotypal features has seldom been studied. We aimed to examine the possible moderation effect of schizotypal traits on ERI and reward motivation. Eight-hundred-and-forty-three college students were recruited online to complete a set of self-reported measures capturing schizotypal traits, effort-reward imbalance and reward motivation, namely the Schizotypal Personality Questionnaire (SPQ), the Effort-Reward Imbalance-School Version Questionnaire (C-ERI-S) and the Motivation and Pleasure Scale-Self Report (MAP-SR). We conducted multiple linear regression to construct models to investigate the moderating effects of schizotypal traits on the relationship between ERI and reward motivation. Stressful ERI situation predicted the reduction of reward motivation. Negative schizotypal traits showed a significant negative moderating effect on the relationship between ERI and reward motivation, while positive and disorganized schizotypal traits had significant positive moderating effects. Schizotypal traits subtypes differently moderate the relationship between ERI and reward motivation. Only negative schizotypal traits and stressful ERI situation together have negative impact on reward motivation.

Decoupling between hub-connected functional connectivity of the social brain network and real-world social network in individuals with social anhedonia.

Altered hub regions in brain network have been consistently reported in patients with schizophrenia. However, it is unclear whether similar altered hub regions of the brain would be exhibited in individuals with subclinical features of schizophrenia such as social anhedonia (SA). In this study, we examined the hub regions of resting-state social brain network (SBN) of 35 participants with SA and 50 healthy controls (HC). We further examined the prediction effect of hub-connected FCs with SBN on the real-life social network characteristics. Our findings showed that the right amygdala, left temporal lobe and right media superior frontal gyrus were the hub regions of SBN both in SA and HC groups. In the SA group, the left temporal lobe connected functional connectivity (FC) did not predict social network characteristics, while the other FCs strengthened the association with social network characteristics. These findings were replicated in an independent sample of 33 SA and 32 HC. These findings suggested that the left temporal lobe as one of the hub regions of SBN exhibited the abnormality of their connected FCs in the association with social network characteristics in individuals with SA.